Committee of

Interns and Residents SEIUHealchcare"

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WHEN YOU GET BENEFITS & WHO YOU CAN COVERTo enroll in coverage, complete an enrollment form at orientation. Return the form to your CIR organizer or the CIR Office, Attention: Operations Department within 31 days after your first day of work. Please be sure to name at least one beneficiary for your Life Insurance benefit when filling out the enrollment form.

You and your enrolled family members’ coverage starts on your first day of work.

Outside of Orientation and Open Enrollment, you have 30 days from the date of a qualifying event to add a spouse, domestic partner, and/or child.

Qualifying Life Events:

• Marriage

• Loss of employment/insurance coverage

• Birth of a child

• Dependent(s) arriving in the United States during the year

During Open Enrollment (July or January), please note that:

• When enrolling, you’ll need to provide your and your enrolled dependents’Social Security numbers, a copy of a marriage license, birth certificate (forchildren), or discharge papers from the hospital.

• If you are enrolling a domestic partner, you’ll need to submit the DomesticPartnership application found on the CIR website at cirseiu.org/benefits andselect your hospital’s name.

Welcome to the House Staff Benefits Plan (HSBP)! The HSBP Trustees understand how important it is for you to have additional healthcare coverage. Once you enroll, you'll save on out-of-pocket expenses if you need non-preventive medical or dental care, or for certain vision care expenses – something we hope gives you peace of mind as you focus on the important task of caring for your patients.We believe you’ll find this Benefits-At-A-Glance useful. You can also learn more by:

• Visiting our website (cirseiu.org/benefits and click on your hospital’sname)

• Emailing the Benefits Plan office at benefits@cirseiu.org

• Calling the Benefits Plan Office (212) 356-8180

For a complete description of your benefits and your rights, please read the Summary Plan Description (SPD) — also located on the CIR website under “Benefits” — which also serves as the Plan Document.

With best wishes for a successful and fulfilling medical career,

Your HSBP Trustees

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Con�nuing Learning Program (CLP) - $1,500 Reimbursement

You can also get reimbursed for:

1. Medical Conferences

2. Online Courses

3. Board Review Courses

Get Reimbursed for expenses for Registra�on and Travel Arrangements

Abstract Submission Car Rentals Hotels / Lodging Planes / Trains Registra�on

Cab Rides Gas & Tools Meals Posters Tui�on

Take a course or conference a�er gradua�on• Before you graduate and s�ll on payroll pay for a course or medical conference.• Schedule the course or medical conference within 6 months of termina�on.

Professional Educa�onal Plan (PEP) - $650 Reimbursement

Receive $650 Reimbursement Every Plan Year For One Of The Following

Audio Tapes (MP3’s) Examina�on Fees Pulse Oximeter

Blood Pressure Monitor Journals for Medical Specialty Socie�es Scrubs

Board Exam Fees License Applica�on Stethoscope

Books and eBooks 1 Medical Equipment Surgical Loupes

Mobile Electronic Medical Devices (Laptops, Smart Phones, Tablets)* Surgical Shoes (clogs)

Dues Pen Light Videos Tapes (DVD’s, CD’s)

1 You can receive more than one book only if each book has a different �tle.*The maximum reimbursement for one Mobile Electronic Medical Devices is limited to 75% of the total device cost up to $650.

Only one mobile device per par�cipant per Plan Year (July 1 – June 30). Mobile devices will not be reimbursed if purchased in the last 6 months of your residency.

Carryover Your Balance To The Next Plan YearIf you don’t use the en�re $650 or you only used a por�on you can rollover the balance and use it in the next plan year.

PGYLevel Maximum Reimbursement

1 – 3 $1,5004 – 6 $1,5007 - 9 $1,500

If you are going to go to conferences and/or taking online courses to meet your residency requirements, make sure you submit your expenses to (CLP) and get reimbursed.

You work very hard for your pa�ents safety. Make sure you are u�lizing your Professional Educa�onal Plan Benefits to get reimbursed for expenses you are paying outof your pocket.

Dicta�on Recorder

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Con�nuing Learning Program (CLP) - $1,500 Reimbursement

You can get reimbursed for:

1. Medical Conferences

2. Online Courses

3. Board Review Courses

Get Reimbursed for expenses for Registra�on and Travel Arrangements

Abstract Submission Car Rentals Hotels / Lodging Planes / Trains Registra�on

Cab Rides Gas & Tools Meals Posters Tui�on

Take a course or conference a�er gradua�on• Before you graduate and while s�ll on payroll, p ay for a course or medical conference.. • Schedule the course or medical conference within 6 months of termina�on.

Professional Educa�onal Plan (PEP) - $750 Reimbursement

Receive $750 Reimbursement Every Plan Year For One Of The Following

Audio Tapes (MP3s) Examina�on Fees Pulse Oximeter

Blood Pressure Monitor Journals for Medical Specialty Socie�es Scrubs

Board Exam Fees License Applica�on & Fees Stethoscope

Books and eBooks 1 Medical Equipment or Medical Recorder

Surgical Loupes Mobile Electronic Medical Devices (Laptops, Smart Phones, Tablets)* Surgical Shoes (clogs)

Dues

COVID-19 Medical Equipment Videotapes (DVDs, CDs)

1 You can receive more than one book only if each book has a different �tle.

p* The maximum reimbursement for one Mobile Electronic Medical Device is limited to 75% of the total device cost up to $750. Only one mobile device per

articipant per Plan Year (July 1 – June 30). Mobile devices will not be reimbursed if purchased in the last 6 months of your residency.

Carry Over Your Balance To The Next Plan Year

If you have not used your full benefit, you can rollover the balance and use it in the next plan year.

PGYLevel Maximum Reimbursement

1 – 3 $1,5004 – 6 $1,5007 - 9 $1,500

If you are going to go to conferences and/or take online courses to meet your residency requirements, make sure you submit your expenses to CLP and to receive reimbursement.

You work hard to ensure the safety of your patients. Make sure you are u�lizing your PEP to get reimbursed for expenses you are paying out of your pocket.

Dicta�on Recorder

PEP Tax ImplicationDue to a recent tax law, this may influence how you may choose to use your education benefit. Please note that if you decide to use $600 or more of your education benefit toward initial licensure fees, you will now need to report this as taxable income on your annual tax filing.

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NYC H+H Child Care Reimbursement Benefit

The child care benefit assists you in paying a portion of your child care expenses. Every calendar year, you are eligible to receive up to $3,500 per household. The plan follows IRS Publication 503 guidelines to keep the benefit tax-free. Every bit counts when it comes to day care, so don’t forget to apply for this great reimbursement benefit!

NYC H+H Childcare Reimbursement Benefit - For children under age 13 $3,500 Reimbursement

• We recognize the financial impact of starting a family while going through residency.

• If you are paying for a caregiver to take care of a child while you and your spouse are at work,you can submit proof and receive up to $3,500 each calendar year (January - December).

Caregiver Can Be One of The Following

Family Member Babysitter / Nanny Au Pair Nursery School

Pre-school Recreational Day Camp

Before SchoolProgram After School Program

Housekeeper / Maid / Cook Childcare Facility

Childcare at your home or another person’s house

Childcare programs below Kindergarten

Medical Your primary source of medical and prescription drug coverage is your hospital/employer. To be eligible for this coverage, you must enroll for it through your hospital’s/employer’s benefits department.

Supplemental Reimbursements The Plan will reimburse you for out-of-pocket expenses you incur from your primary medical, dental, and prescription drug insurer.

Types of Supplemental Reimbursement Benefits1. Dental - Up to $1,000

2. Major Medical - Up to $1,000

3. Obstetrical - Up to $1,000

4. Newborn - Up to $1,000

5. Outpatient Mental Health - Up to $5,000

6. Prescription Drugs - Up to $750

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Supplemental Dental Reimbursement Benefit $1,000 Reimbursement

This benefit supplements your dental coverage. The plan pays 20% of what your dental carrier pays the provider, up to a maximum of $1,000 per person, per plan year (July1-June30). Submit your Explanation of Benefits (EOB) with a reimbursement form found on the CIR website (cirseiu.org/benefits and click on your hospital's name).

$1,000 ReimbursementSupplemental Major Medical Reimbursement Benefit

This benefit supplements your medical coverage. The plan pays 20% of what your medical carrier pays the provider, up to a maximum of $1,000 per person, per plan year (July1-June30). Submit your Explanation of Benefits (EOB) with a reimbursement form found on the CIR website (cirseiu.org/benefits and click on your hospital's name).

Supplemental Obstetrical Reimbursement Benefit $1,000 Reimbursement

Lactation Classes, as well as breast pumps and accessories are eligible for this reimbursement.

Transgender Benefits Are Part of Your Supplemental CoverageTransgender benefits are provided to those who need access to medical and surgical care to transition to the appropriate gender. Transgender benefits coverage includes knowledgeable primary care, HRT and prescription medication, access to gender-specific and transition-related care as well as mental health outpatient care.

• Supplemental Outpatient Mental HealthBenefit: Reimburses up to $5,000.

• Supplemental Major Medical Benefit:Reimburses up to $1,000.

• Supplemental Prescription Drug Benefit:Reimburses up to $750.

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Supplemental Newborn Reimbursement Benefit $1,000 Reimbursement• If you have any unreimbursed medical expenses for the first 60 days of your child’s life, such as pediatrician’s

fees for in-hospital newborn care or circumcision performed by a certified mohel, requests for children up to24 months of age can be submitted for reimbursement.

• You can also use this benefit for Childbirth Education for up to six group sessions or 3 – 4 private sessionsconducted by an accredited practitioner. Accreditation through one of the following organizations is required:CEA-International Childbirth Education Association; American Academy of Husband Coached ChildbirthEducation Association; ASPO-National Organization for the Lamaze Method; Childbirth Education Specialist, Inc.

Supplemental Outpatient Mental Health Reimbursement Benefit $5,000 Reimbursement• You can get reimbursed up to $160 per outpatient mental health visit with an eligible certified and licensed

provider.

• Your eligible provider must complete your claim form(s) with the exact date(s), diagnosis, and procedurecodes for which services were rendered.

Supplemental Prescription Drug Benefit $750

• This supplemental prescription drug coverage should be used with your employer’s primary prescriptiondrug plan.

• The Plan highly recommends that you enroll in the employer’s prescription drug plan for yourself and, ifapplicable, your family. Whenever possible, use your primary prescription drug plan coverage before usingthis benefit.

• Prescription drug debit cards will be issued at $750 per eligible family member. Members can obtaindiscounts for prescription drugs at any Express Scripts provider nationwide.

This is a sample of the Prescription ID card, which includes your CIR Member ID number. You will receive this ID card in the mail from the insurer. Only the primary card holder’s name will appear on the ID card.

Employee Assistance Program (EAP) with WorkLifeMattersWe are here to support you in managing life's challenges. It’s a free confidential employee assistance program provided through Guardian and Integrated Behavioral Health (IBH). Counselors are available 24/7 and are just a phone call away. WorkLifeMatters offers help for anxiety and depression, relationship issues, and drug and alcohol abuse.

• Anxiety• Dependent Care & Caregiving• Depression• Drug & Alcohol Dependency

• Education• Grief Assistance• Legal & Financial• Lifestyle & Fitness Management

• Parenting• Pet Care• Work Issues• And More

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This is a sample of the Vision ID card, which includes your CIR Member ID number. You will receive this ID card in the mail from the insurer. Only the primary card holder’s name will appear on this ID card.

Vision BenefitsIt’s easy to take good vision for granted. However, getting your vision checked each year is just as important as your annual physical or routine dental check-up. That’s why the Plan offers vision benefits through Davis Vision, which includes eye exams, eyeglass lenses and frames, and contact lenses.

Vision Benefits At-A-Glance (Amounts are what YOU pay) VISION BENEFIT

In-Network Benefit Davis Vision Provider

FREE EYE EXAM(one exam every year beginning July 1) $0

CLEAR PLASTIC LENSES (one pair every year beginning July 1) $0

FRAMES (Every July 1) Davis Vision Collection $0 co-pay for Fashion Frames

$0 co-pay for Designer Frames

$0 co-pay for Premier Frames

CONTACT LENSES – In lieu of eye glasses$0 for Collection Contacts and lens fitting.Or, Non-Collection Contacts: 15% discount of balance and lens fitting fee

SCRATCH PROTECTION PLAN $20 for Single Vision Lenses $40 for Multifocal Lenses

Out-of-Network Benefit

You will receive a maximum of $50 per year toward an eye exam and $150 toward materials. You must file a claim with Davis Vision to be reimbursed. This applies to eyeglasses or contact lenses.

Dental Benefits with Guardian InsuranceIf your address is within the Tri-State Area (NY, NJ, CT) you are defaulted into the Managed Dental Guard (MDG) Plan. This plan lowers your cost for services rendered. You will be assigned a dentist near your home. If you already have a dentist and you want to continue to see that dentist, contact Guardian before July 30th or during the periods of open enrollment (either in July or January).

If your address is outside of the Tri-State area you will be defaulted into the Dental Guard Preferred (DGP) Plan. This option is typically used for those residents whose family will continue to live outside the Tri-State area. This plan allows you greater choice of dentists but you will pay more for services.

Dental Benefits At-A-Glance(Amounts are what YOU pay)

MANAGED DENTAL GUARD

DENTAL GUARD PREFERRED Freedom to Go to Any Dental Provider

In-Network Only Preferred Provider Non-Preferred Provider

PREVENTIVE CARE $0 $0 $0* DIAGNOSTIC VISIT (including bitewing X-rays) $0 20% 20%*

MINOR SERVICES(including crowns and bridges) $0 – $316 20% 20%*

MAJOR SERVICES (including oral surgery) $0 – $625 50% 50%*

ORTHODONTICS $0 – $2,425 $1,800 Lifetime Maximum

$1,800 Lifetime Maximum

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This is a sample of the Dental ID card. You will receive this ID card in the mail from the insurer. Each family member will receive their own ID card.

Managed Dental CarePlan Holder: Plan Number:Subscriber:Subscriber ID:Member:Network: MANAGED DENTAL GUARDPlan: Office Visit Copay:DDS Office Name:DDS Office Number: For Appointments:

*You pay any charges above the Usual and Customary Rate (UCR). There is a $25.00 annual deductible.

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HSBP CIR LEGAL SERVICES BENEFIT (CIRLS)

New Educa�on Loan Debt Benefit - Consulta�on & Paperwork

EDUCATION LOAN DEBT BENEFIT MEMBER RESPONSIBILITY

Ini�al Consulta�on

$79

Ini�al Paperwork (No Consulta�on) $129

Ini�al Consulta�on & Paperwork $188

Paperwork (Subsequent Years A�er Ini�al Consulta�on) $109

Subsequent Consulta�ons (If Necessary) $179

• You are eligible for an individual educa�on loan consulta�on at a 60% discounted rate.

• Consulta�on includes a review of your loan por�olio and a discussion to ensure you are posi�oned to obtain themaximum savings and lowest payment available. Consulta�ons may be held in-person or conducted over thephone.

• In addi�on, you can purchase an educa�on loan paperwork processing service to prepare and submit thedocumenta�on necessary for your loan repayment op�on.

• You could poten�ally save thousands of dollars during the length of your loan.

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For details see the HSBP CIR Legal Services Summary Plan Descrip�on found on the CIR webiste. Click “Benefits” and then click on yourhospital from the drop-down menu.

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LEGAL SERVICES COVERED AT CIRLS HOSPITALS

Bankruptcy and Debt Problems Educa�on Loan Debt Medical Licensure

Consumer Protec�on Employment Contract Review Name Changes

Credit Ra�ng Estate Ma�ers Real Estate

Criminal Ma�ers Family Ma�ers Unemployment Benefits

Document Review Immigra�on

Educa�on Law Landlord – Tenant Problems

• Review of your wri�en contract by an a�orney who specializes in physician employment contracts, followed by a discussion about the terms of thecontract by phone or in-person.

• Covers contracts for employment in NY, NJ, CT, CA, FL, MA, MD, NM, PA, VA, WA and Washington, DC.

• The cost of the review is discounted to $400 for all CIR members. You will receive an addi�onal discount from CIR Legal Services, which will pay $200toward the fee. (Typical cost for contract review can range from $600 to $1,300).

• You will only pay $200.

• Receipt of a CIR-prepared post-residency employment contract packet designed to enable you to be�er understand your contract. Includes a valuablechecklist.

*The Contract Review Benefit may only be used once by a CIRLS par�cipant during their residency or fellowship.

Employment Contract Review Benefit - You Pay Only 50% of the CIRLS Discounted Cost*

Wills, Living Wills and Power of A�orney

QI/Patient Safety Educational Benefits

HSBP is committed to offering residents additional education and training to help you deliver safe, efficient, and effective care to your patients.

QI/Training Scholarships:

• HSBP provides scholarships for eligible covered residents to attend one approved QI/Patient Safety Educationand Training program available in the U.S. Participants will be eligible to receive a scholarship of up to $3,000per residency year to cover expenses related to registration, travel, and tuition.

• Covered residents accessing this benefit are responsible for securing time off (vacation or education leavetime) to attend or participate in these educational opportunities.

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Patient Care Trust Fund (PCTF)

The Patient Care Trust Fund (PCTF) is a non-profit foundation established by CIR members to support patient care and safety improvements in the NYC Health + Hospitals system.

Each academic year, the PCTF provides eligible house staff with significant grants to lead clinical research and quality improvement projects at their facilities, obtain cutting-edge medical equipment and training materials for their programs, and partner with community-based organizations to impact population health in medically-underserved communities. The PCTF also offers a small “Holiday Grant” for residents in Pediatrics and Pediatric subspecialty programs to host festive, end-of-year celebrations and events for their patients.

Grant applications open and close at different times between September and March of each academic year. Before each grant cycle, PCTF staff will hold “how to apply” information sessions and events at your hospital. Only interns, residents, or fellows employed by NYC Health + Hospitals or by Mt. Sinai at Elmhurst Hospital may apply for PCTF funding.

To learn more about PCTF grants and view our grant calendar, please visit www.cirseiu.org/pctf or contact

the Patient Care Trust Fund at PCTF@cirseiu.org or 212-356-9815.

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Disability Benefits

For purposes of our disability benefits, “disabled” means you can no longer perform the duties of your occupation due to accidental bodily injury, sickness, or a related medical condition, including pregnancy or childbirth. You must also be under the care of a licensed provider as defined by the state in which you work.

Short-Term Disability (STD):

• Coverage begins on the eighth (8th) day of your disability. The maximum benefit payable is 70% of your weekly salary, up to $875per week, for up to 26 weeks.

• For complete guidelines, refer to your Summary Plan Description booklet.• If you are going out on a disability leave, contact your employer as soon as possible.

Long-Term Disability (LTD):

• The LTD plan pays you 70% of your monthly salary, up to a maximum of $3,500 per month.

• LTD benefits typically start if you are still disabled after 26 continuous weeks.• When you terminate employment, you will have the option to convert this benefit to an individual policy, subject to certain

conditions.

Even More BenefitsHearing Aid Benefit. A hearing test should be part of your regular health maintenance plan. Contact EPIC Hearing Healthcare.

Term Life Insurance. If you die, a death benefit of $150,000 will be paid to any beneficiary you name. A death benefit of $20,000 will be paid to you if your legal spouse or domestic partner dies from any cause.

Identity Theft Monitoring. Enroll in this free service while on your hospital’s payroll. The IdentityForce Program will provide online global monitoring of:

• Bank account numbers• Credit and debit cards• Credit scores from one credit bureau• Email addresses• Medical ID numbers• Passport numbers• Phone numbers

Other Important Information and Required Notices can be found in the Summary Plan Description (SPD)/Plan Document.

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CONTACT INFORMATIONFor questions on benefits coverage, please see the information below:

BENEFIT ADMINISTRATOR CONTACT INFORMATION

DentalGroup # G-417732

Guardian Managed Dental Guard (MDG)Phone: (888) 618-2016Days/Hours: M – F, 9:00 a.m. to 8:00 p.m. EST

Website: www.guardiananytime.comGuardian Dental Guard Preferred (DGP)

Phone: (800) 541-7846Days/Hours: M – F, 9:00 a.m. to 8:30 p.m. EST

Website: www.guardiananytime.com

Education Loan Debt CIR Legal Services (CIRLS) Phone: (212) 356-8195 Days/Hours: M – F, 9:00 a.m. to 5:00 p.m. EST Email: cirls@cirseiu.org Website: www.cirseiu.org/legalservices

Employee Assistance Program (EAP)

Guardian Integrated Behavioral Health (IBH) Phone: (800) 386-7055 / Emergency access 24/7 Days/Hours: M – F, 9:00 a.m. to 8:00 p.m. EST

Website: https://ibhworklife.personaladvantage.com

Username: Matters / Password: wlm70101

Hearing Aid EPIC Hearing Healthcare* Phone: (866) 956-5400*Identify yourself as a CIR House Staff Benefits Plan MemberDays/Hours: M – F, 6:00 a.m. to 6:00 p.m. EST

Website: www.epichearing.com/individual-family-plans/already-epic/

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This Benefits-At-A-Glance describes your benefits provided through the HSBP Trustees for you and your covered dependents as of July 1, 2020. The only authorized information concerning your benefits is in writing from the Trustees acting in their official capacity and whose sole decision regarding benefits is final. The Trustees reserve the right to change or discontinue the eligibility rules and the type and amounts of benefits under this Plan at any time. Please read the Summary Plan Description (SPD)/Plan Document for more information.

BENEFIT ADMINISTRATOR CONTACT INFORMATION

Legal Services CIR Legal Services Plan (CIRLS) Phone: (212) 356-8195Days/Hours: M – F, 9:00 a.m. to 5:00 p.m. EST Fax: (212) 504-3057 Email: cirls@cirseiu.orgWebsite: www.cirseiu.org/legalservices

Life InsuranceGroup # G-348692

Guardian Life Insurance Phone: (800) 525-4542Days/Hours: M – F, 8:00 a.m. to 6:00 p.m. EST Fax: (610) 807-2724 Website: www.guardiananytime.com

Prescription DrugGroup # JRGA

Express Scripts, Inc. (ESI) Phone: (866) 439-3658 / Pharmacist only: (800) 235-4357 TDD for hearing impaired: (800) 972-4348Days/Hours: M – F, 9:00 a.m. to 5:00 p.m. ESTWebsite: www.express-scripts.com

Short-Term Disability Long-Term Disability

HSBP Fund Office Phone: (212) 356-8180Days/Hours: M – F, 9:00 a.m. to 5:00 p.m. EST Email: benefits@cirseiu.org Website: www.cirseiu.org/benefits

Vision Davis Vision (Client code: 2200) Phone: (800) 999-5431 / automated assistance available 24/7Days/Hours: M – F, 8:00 a.m. to 11:00 p.m. EST; Sat., 9:00 a.m. to 4:00 p.m. EST; Sun., 12:00 p.m. to 4:00 p.m. ESTWebsite: www.davisvision.com and enter client code 2200

CONTACT INFORMATIONFor questions on benefits coverage, please see the information below:

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10-27 46th Avenue, Suite 300-2Long Island City, NY 11101Phone: (212) 356-8180Days/Hours: M – F, 9:00 a.m. – 5:00 p.m. ESTFax: (212) 356-8181Email: benefits@cirseiu.org

The House Staff Benefits Plan staff can help with all areas of benefits, including questions about appeals, COBRA, reimbursements, ID cards and more.

For questions about the Plan, contact the HSBP office.